My brother (age 29) had radial keratotomy 15 years ago and

Resolved Question:

My brother (age 29) had radial keratotomy 15 years ago and his eyesight improved for a brief period following the procedure, but it has deteriorated significantly since to -13.75d and -11.00d respectively and he has severe astigmatism. He has also been diagnosed recently with a posterior subcapsular cataract, peripheral retinal degeneration and macular degeneration. A clinic told him that LASIK can fix all that but he is looking for a second opinion. Some of these sound quite scary, do you have a view?

It sounds as though your brother has experienced significant regression in his refractive error (need for glasses) after the RK.

In eyes that have had previous corneal refractive surgery performed on them, a thorough evaluation must be performed to determine whether or not LASIK is appropriate for the patient, given their previously altered corneas. In the right setting, a patient with severe myopia and severe astigmatism may indeed be helped by laser refractive surgery such as LASIK, even after RK, but the circumstances have to be right. A good LASIK surgeon will evaluate all of his measurements and take into account his exam to arrive at what is the safest and most beneficial option to help your brother's refractive situation. If you feel like this surgeon does not have your brother's best interests at heart, or you feel uncomfortable with his/her recommendation, it would be wise to seek a second opinion.

As far as the retinal diagnoses, peripheral retinal degeneration and macular degeneration, the retinal degeneration is consistent with a long eye (these eyes that are long are very nearsighted and typically have thin retinas). This can put him at risk for retinal breaks/holes/tears with intraocular surgery, but many people still have surgery with this condition and do just fine. The macular degeneration diagnosis is a bit puzzling because it is quite usually a diagnosis made an elderly person. That being said, however, there are forms of retinal disorders that may mimic macular degeneration that can be seen in younger individuals, and this may be the case with him. However, LASIK will do nothing to help any retinal condition.

As far as his posterior subcapsular cataract, the only thing that can improve this condition is cataract surgery, which can be very beneficial to his vision if the cataract is indeed causing him significant vision problems.

Does this help address your concerns?

I am happy to be able to help you today. If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button for this encounter. I will also be happy to answer any other questions until you have the information you need.

Any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. Thanks for your inquiry!

My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.

- the thinning of the retina is part of the very high myopia - with LASIK the eye will be reshaped and while the retina won't recover, it likely won't be as 'stretched' in the future and at risk of detachment? what happens if the retina is torn after LASIK?

- there is a separate surgery needed to fix the cataract? should it be performed before or after LASIK?

A thinning retina can be a form of peripheral retinal degeneration, but it may not be a thin retina unless the ophthalmologist said it was. It is just a common presentation with someone who is so myopic.

The cornea is what is reshaped in LASIK and so given that this is not intraocular surgery (surgery on the inside parts of the eye) the risk that LASIK causes problems with a thin retina are less than say cataract or retinal surgery, but not zero.

There is a separate surgery needed to remove the cataract (a cloudy lens). In that separate surgery the cataractous lens is removed and an artificial lens is inserted in its place. The retina can tear with any ocular surgery, but I would suspect cataract surgery (given that it is an intraocular surgery) would be a more likely cause of a retinal tear/hole/break or detachment than LASIK, as it is not an intraocular surgery, but there are still significant forces placed on the eye in LASIK as well, so that risk is there with it, too.

Generally, it is best to do cataract surgery prior to LASIK because the refractive status of the eye (thickness and curvature of the cornea, specifically) is intact and can be counted on to give reliable measurements for artificial lens calculations in cataract surgery if the cataract surgery is done first. While it is not impossible to do cataract surgery after LASIK, the reliability of measurements and predictions of post-operative refractive errors become less reliable if the LASIK is done before the cataract surgery.

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me.Susan O.USA

I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me.Susan O.USA

This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!!AlexLos Angeles, CA

Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult.GPHesperia, CA

I couldn't be more satisfied! This is the site I will always come to when I need a second opinion.JustinKernersville, NC

Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around. EstherWoodstock, NY

Thank you so much for taking your time and knowledge to support my concerns. Not only did you answer my questions, you even took it a step further with replying with more pertinent information I needed to know. RobinElkton, Maryland

Ask an Eye Doctor

Get a Professional Answer. 100% Satisfaction Guaranteed.

58 Eye Doctors are Online Now

Type Your Eye Question Here...

characters left:

Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.